Simulation training incorporating a smartphone app increases Foundation Doctors’ confidence in managing cardiac arrest Dr Richard Thomas, Dr Emma Norman, Dr Aidan Joyce Hampshire Hospitals NHS Foundation Trust

Backgound 55 Foundation Doctors based at Royal Hampshire County Hospital (28FY1 and 27FY2) have protected bleep-free teaching every Wednesday afternoon for 90mins. Simulation training (small groups of 4-8 FY doctors) has been introduced gradually over the last 3 years and runs in parallel with the lecture-based programme. Simulation training is very popular with FY doctors, but faculty intense and requires significant organisation. FPD had an i-phone for his birthday!

Aims We wanted more information about the effectiveness of the simulation training delivered at RHCH. We wanted more information about FY1 experience of cardiac arrest. (Recent BMJ article) We wanted to explore why a generation of “IT aware” smartphone owners do not seem to instinctively use apps to guide them through high stress situations.

Initial survey Anonymous written questionnaire to ask FY2 Doctors (n=20) about their experience and confidence levels in attending cardiac arrests and performing related clinical skills Completed at first simulation training session

Confidence in clinical skills Completely Confident / Confident Neutral / Not very confident / Unconfident 1. Performing chest compressions? 100%0% 2. Ventilating a patient with a bag- valve mask? 75%25% 3. Setting-up and using the defibrillator at a cardiac arrest? 30%70% 4. Obtaining Intra-Osseous access? 5%95% 5. Leading a cardiac arrest?5%95%

Delivered in purpose built simulation suite with “3G” mannikins. Team of 3 trainers: FPD (Consultant Anaesthetist), SAS Anaesthetist and Resus / sim training officer. Simulation-based training

2 x 90 minute sessions. 3 x scenarios per session. Repeated Groups of 6 FY2s, in pairs. Revision of “apps”, BLS, ALS, defib, EZ I-O drill pre-session Asystolic Cardiac arrest post MI. Management of Ventricular tachycardia. Anaphylaxis post antibiotic drug administration. Simulation-based training

Resus Algorithms Free smartphone app Based on current UK Resuscitation Council Guidelines Includes guidance on cardiac and peri-arrest algorithms Trainees encouraged to use the app however they wished.

Re-survey Completely Confident / Confident Neutral / Not very confident / Unconfident % Change compared to pre- training results 1. Perform chest compressions? 100%0%None 2. Ventilating a patient with a bag- valve mask? 100%0% 25% increase 3. Setting-up and using the defibrillator at a cardiac arrest? 87%13% 57% increase 4. Obtaining I.O. access? 62%38% 57% increase 5. Leading a cardiac arrest? 62%38% 57% increase

Using an app: Percentage of doctors who found the app useful during this training: 93% Percentage of doctors who had or would consider using the app at a cardiac arrest: 75%

Discussion Initial survey (undertaken in the first 4/12 of FY2) showed that the doctors surveyed had attended relatively few cardiac arrests, with 95% having a attended 5 or less. In this context, they did not feel confident undertaking more complex or skilled roles at arrests. Our results demonstrate that their confidence can be improved by simulation based training, supported by a smartphone app.

Discussion The doctors found using an app to be a useful part of the training, and the majority would consider using it at a cardiac arrest. They did make some criticisms of the app: ‘Too cumbersome’ and ‘doesn’t include all the drug doses’. One trainee thought it was ‘a poor second to knowing the algorithms by heart’. There was a perception that using an app was “cheating”.

Key messages Our version of sim-based training increases our junior doctors confidence in their ability to manage cardiac arrest. Senior clinician delivered and led. The majority of junior doctors found a smartphone app to be a useful tool in a training environment. Senior clinician “endorsement” helps.

Questions? To download Resus Algorithms for iPhone: algorithms/id ?mt=8 or use the QR code in the bottom right corner algorithms/id ?mt=8 To download Resus Algorithms for Android: ctiveeffect.resus&hl=en_GB or use the QR code in the bottom left hand corner ctiveeffect.resus&hl=en_GB Thank you